Generalized Anxiety Disorder And Theoretical Models

In one way or another, we are all familiar with the concept of anxiety. We know that it affects each person in their own way and that there  are several diseases associated with it. One of them is generalized anxiety disorder. The Diagnostic and Statistical Manual of Mental Disorders  (DSM-5) defines anxiety in several ways, including in the form of generalized anxiety disorder (GAD).

This disease is  characterized by the presence of anxiety and excessive, persistent anxiety that can be difficult to control. These clouds of anxiety can be about different events or activities, and are the result of three or more symptoms of physiological overreactions. Furthermore, patients with GAD will suffer from anxiety or worry during most days for  at least six months.

The development of generalized anxiety disorder (GAD)

The third edition of the Diagnostic and Statistical Manual of Mental Disorders  (DSM-III, APA, 1980)  initially introduced GAD as a single diagnosis. However, experts often use it as a residual diagnosis for individuals who did not meet the diagnostic criteria for other anxiety disorders (1).

The publication defined GAD as a chronic and compelling concern (2). In the next edition, DSM-IV TR, it was instead characterized as an  excessive concern about various problems beyond the victim’s control, which occur during most of the days for at least six months. This excessive anxiety causes discomfort and / or functional impairment. It also consists of at least three of the following aspects:

• Restlessness or feelings of upset or nervousness.
• Fatigue.
• Concentration difficulties.
• Irritability.
• Muscle tension.
• Sleeping problems.

Psychiatric medication and cognitive behavioral therapy (CBT) are used to treat GAD  (3, 4, 5). Pharmacotherapy may be effective in reducing anxiety symptoms, but medication does not appear to have a significant effect on anxiety, which is a defining characteristic of GAD (3).

Current theoretical models for generalized anxiety disorder

The avoidance model of anxiety about generalized anxiety disorder

The avoidance model of anxiety (6) is based on Mowrer’s dual theory of fear (1974). It has also based some of its concepts on Foa and Kozak’s theory of emotional processing (7, 8). The avoidance model of anxiety states that  verbal linguistic and thought-based activity arises as an attempt to inhibit intense mental images and associated somatic and emotional activation.

More specifically, this inhibition excludes the emotional processing of fear, which is theoretically necessary for the successful habituation and eradication of stimuli one is afraid of.

The Uncertainty Intolerance Model (IUM)

According to this model, people with generalized anxiety disorder find situations with uncertainty or ambiguity as “stressful and annoying”. As a result, they experience chronic anxiety in response to these situations (10).

These individuals believe that  anxiety will help them better cope with the events that lead to fear. They may even believe that this will prevent these events from occurring  (11, 12). This worrying together with the related feelings of anxiety leads to a negative way of dealing with the problem. In the same way, it also leads to cognitive avoidance, which strengthens anxiety.

More specifically, people who use a negative way to deal with the problem may:

• Have a lack of security in their own abilities to solve problems.
• Perceive the problems as threats.

• Get easily frustrated when faced with a problem.
• Be pessimistic about the outcome of their effort when it comes to solving a problem.

These thoughts only aggravate their anxiety (10).

The Metacognitive Model (MCM) for generalized anxiety disorder

The metacognitive model of generalized anxiety disorder states that individuals with GAD experience two types of anxiety. Wells – the author behind the model – defined type 1 concerns. This is when a person worries about non-cognitive events, such as external situations or physical symptoms (Wells, 2005).

For Wells, individuals with GAD begin to worry about their type 1 anxiety. They worry that their anxiety is uncontrollable or that it can be dangerous in itself. This “concern about anxiety” (ie meta-anxiety) is what Wells in turn calls type 2 anxiety. Wells associates this type 2 anxiety with a set of ineffective strategies aimed at avoiding anxiety. These strategies consist primarily of attempts to control behaviors, thoughts, and / or emotions (10).

The model of emotional dysregulation (EDM)

The model of emotional dysregulation (EDM)  is based on literature on emotion theory and the regulation of emotional states in general. This model consists of four key components (10):

• The first says that individuals suffering from generalized anxiety disorder experience  emotional hyperactivation. In other words, their emotions are more intense than others. This applies to both positive and negative emotions, but above all the negative ones.
• The other assumes that individuals with GAD have a poor understanding of emotions. This includes, for example, deficiencies in the ability to describe and label emotions. It also includes access to and use of useful information that involves emotions.

• Next, the third states that individuals with GAD have more negative attitudes about certain emotions than other people.
• Finally, the fourth specifies that these  individuals have little or no adaptive regulation of emotions. Similarly, they also have coping strategies that potentially leave them in emotional states that are even worse than the ones they initially tried to regulate.

Acceptance-based model for generalized anxiety disorder (ABM)

According to authors Roemer and Orsillo, ABM involves  four components:

• Internal experiences.
• A problematic relationship to internal experiences.
• Experientially avoidant.
• Behavioral restriction.

Therefore, the creators of this model suggest that individuals with GAD have negative reactions to their own internal experiences, and are motivated to try to avoid these experiences. It is something they do both behaviorally and cognitively (by repeatedly starting the anxiety process).

In summary  , the five theoretical models share an important characteristic. They focus primarily on the consequences of using the avoidance of internal experiences as a management technique.

In recent years, research has made significant progress in theorizing about this disease. However, there is a need for more basic research on the predictive components of the five models of generalized anxiety disorder.